To Study Retrograde Autologus Priming (RAP) As An Important Blood Conservation Modality And Its Role In Post Operative Outcome - A Study Of 200 Cases In Madras Medical College, Chennai

AIMS AND OBJECTIVES : To study the effect of retrograde autologous priming techniques on transfusion requirements and outcome in CABG patients. 1. The effect on peri-operative transfusion requirements. 2. The effect on post-operative morbidity. 3. The effect on duration of post operative stay MATERIALS AND METHODS : We analysed the patient details retrospectively using the charts as well as our clinical clinical workstation. Categorical data were expressed as frequency and percentage. Categorical data were expressed as frequency and percentage. Continuous variable expressed as mean standard deviation. Significant differences between proportions determined by Chi-squared analysis or Fischer‘s exact test. All analysis were carried out using Statistical Package for Social Service version 16(SPSS Inc.,Chicago, IL, USA). Probablity values p<0.05 were considered significant. RESULTS: We had a total of 200 patients in our series from 2014-15. Coronary artery disease is more common in males 83% of our study group. Commonly seen in Diabetics(60%), hypertensives(62%) and smokers(30%), their respective percentages in the study population. Analysing Retrograde autologus priming as a blood conservation modality we were able to derive at a reduction in hemodilution, transfusion rates, creatnine and lactate levels, period of stay but were not able to exhibit statistical significance. The factors like intra operative hemodilution(p=0.039) and transfusion(p=0.050). Post operative creatnine levels(p=0.026) and Stay in the ICU(p=0.014) were significant. CONCLUSION: We were able to establish Retrograde Autologus Priming as one of the blood conservation modalities. As in other literature, our study also suggests that Retrograde Autologus Priming of cardiopulmonary bypass circuit as an effective blood conservation modality. There is a significant reduction in the total transfusion rates of patients in the Retrograde Autologus Priming group in the overall study. Though only the intra op transfusion rates and post operative critical care stay were deemed statistically significant, in this retrograde study, It is promising to note and could get more gratifying results if there could be a prospective study with strict transfusion triggers

Autotransplantation of the Heart for Recurrent Inflammatory Myofibroblastic Tumor

We report a rare case of dyspnea caused by a cardiac tumor in a 53-year-old woman. The patient had undergone a cardiac tumor (inflammatory myofibroblastic tumor, 6.2 × 4.2 × 3.3 cm) resection at our institute 13 months earlier. We performed preoperative evaluations which revealed a cardiac tumor originating from the posterior wall of the left atrium. Cardiac autotransplantation surgery (cardiac explantation, ex vivo tumor resection, cardiac reconstruction, and cardiac reimplantation) was successfully performed for the complete resection of the recurrent tumor without major postoperative complications. The patient showed good physical conditions for 21 months after the surgery. Cardiac autotransplantation is a safe and feasible technique for the complete resection of complex left atrial tumors.

A Case of Autologous Tragal Perichondrium Graft in a Patient with Mooren's Ulcer

PURPOSE: To report the effectiveness of an autologous tragal perichondrium graft for an active Mooren's ulcer. CASE SUMMARY: A 49-year-old male was referred to our clinic with Mooren's ulcer in his left eye. On the first visit, the ulcer involved the entire 360 degrees of the peripheral cornea and the visual acuity was 0.04. As the ulcer did not respond to medical treatment and progressed rapidly, the authors decided on surgical treatment. First, the involved cornea and nearby conjunctiva were removed and the defect was successfully reconstructed with autologous tragal perichondrium and allogenic limbal graft. The progression of corneal ulceration ceased after surgery and the patient's symptoms remarkably improved. Additionally, the graft showed rapid vascularization and engraftment within a week. However, as the opacity evolved and progressed to the central cornea, penetrating keratoplasty (PKP) was performed 5 months after the perichondrial graft. There was no rejection and corneal translucency was kept clear with low-dose steroid eye drops until 6 months after PKP without any sign of limbal deficiency. The patient's final best corrected visual acuity was 0.125. CONCLUSIONS: The present study shows that autologous tragal perichondrium graft is an effective method of treatment for active Mooren's ulcer by defect reconstruction and results in survival of the co-transplanted graft as well as maintaining corneal functions.

Efficacy of Autologous Tragal Perichondrium Graft after Proper Antifungal Treatment in Fungal Necrotizing Scleritis

PURPOSE: To compare the efficacy of an autologous tragal perichondrium graft after proper antifungal treatment between 2 cases of fungal necrotizing scleritis. CASE SUMMARY: A 58-year-old female was referred to our clinic with fungal necrotizing scleritis of the left eye which had occurred after pterygium removal. Scleral melting around calcification was observed. After proper treatment with antifungal agents, the authors performed autologous tragal perichondrium graft; however, 3 months after surgery, a necrosis of sclera recurred and the, patient underwent additional treatment with antifungal agents. No complication has been observed up to 3 months postoperatively. A 36-year-old male visited our clinic with ocular pain and decreased visual acuity associated with necrotizing scleritis which occurred after local conjunctival resection. After 4 weeks of antifungal treatments, scleral lesions were stabilized and the authors confirmed negative findings with repetitive fungus smear test. Therapeutic autologous tragal perichondrium graft was performed, and no complication was observed 3 months postoperatively. CONCLUSIONS: When treating a patient with fungal necrotizing scleritis, preoperative antifungal therapy and confirmation of negative findings in repetitive fungus smear test are important. Autologus tragal perichondrium graft accompanied with proper antifungal therapy is an effective treatment of fungal necrotizing scleritis.

Repair and reconstruction of segmental long bone defect:Theory and application advances / 中国组织工程研究

BACKGROUND:Various methods have been reported for the repair and reconstruction of long bone segmental defect, but al of them have different advantages and disadvantages which limit their wide application. And this stil presents as a huge problem for many orthopaedics. OBJECTIVE:To review the latest research on reconstruction and repair of long bone segmental defects at national and international level. METHODS:A computer-based retrieval was conducted in PubMed database, CNKI database and VIP database by the first author for the articles published from January 1990 to December 2012, on the repair and reconstruction of long bone segmental defect with the key words of“bone defect, long bone reconstruction, tissue engineering of bone, scaffolds, bone reconstruction, bone graft, bone tumor, tumor resection, musculoskeletal tumors, regeneration, autografts”in English and“large segment, bone defects, bone tumors, soft tissue tumors, tumor resection, tissue engineering, bone graft”in Chinese. A total of 104 articles were screened out, and final y, 52 articles were included for further research. RESULTS AND CONCLUSION:Traditional method for the repair of long bone segmental defect includes autologous or al ogeneic bone graft, bone lengthening and artificial prosthesis replacement. The development of prosthesis that was suitable for child limb salvage and consistent with the child growth characteristics has become the chal enge to child limb salvage. In order to solve the problem, we designed the prosthesis that can continuously extent, and applied for the limb salvage reconstruction of tumor. With the development of medical technology, al kinds of artificial bone, especial y bone tissue engineering and gene treatment are being gradual y used to repair bone defect, which wil further enhance the clinical evaluation of bone defect repair, and that is the direction of further research.

A Case of Tricuspid Leaflet Augmentation for Severe Secondary Tricuspid Regurgitation / 日本心臓血管外科学会雑誌

A 71-year old woman, who underwent direct closure of an atrial septal defect with mild tricuspid regurgitation (TR) 18 years previously, suffered terminal cardiac failure with extreme cardiomegaly, mitral regurgitation and severe TR. Medical treatment gradually became ineffectual and we decided to perform surgical therapy. Mitral annuloplasty with a prosthetic ring, tricuspid valve repair, plications of extended bilateral atrium walls and epicardial ventricular pacemaker implantation were performed. In tricuspid valve repair, anterior tricuspid leaflet was augmented by use of glutaraldehyde-preserved autologus pericardial patch and tricuspid annuloplasty with addition of a slightly larger prosthetic ring. Atrio-ventricular regurgitations disappeared and she was discharged 63 days after the operation. Valve extension is a very effective technique to treat severe secondary TR, and long term follow-up is necessary.

Autologus serum in treatment of dry eye disorder: An evaluation.

Dry eye syndrome is a common disorder of the tear film in which eye is unable to maintain a healthy layer of tears to coat it. Despite various conventional treatments such as ocular surface lubrication, artificial tears, protective glasses and punctal occlusion many patients continue to have signs and symptoms of dry eye. That’s why autologous serum eye drops have been indicated for the treatment of dry eye. Therefore, to evaluate the effectiveness of the autologous serum eye drops in dry eye disorder, a total of 34 eyes of 20 patients were included in this study, who used autologus serum eye drops along with artificial tears. Out of 20 patients, 16 were males and 4 were females with M: F ratio of 4:1. The mean age of the patients was 51.95 years. Evaluations of patients were done before and after treatment in follow up, by determining the subjective and objective scores which showed that after follow up of 2 months all the subjective and objective scores were reduced in 28 eyes but 6 eyes did not show any improvement at follow up of 2 months as they stopped the drops after one month of use because of discomfort.

A case of pneumocephalus during labor epidural analgesia: A case report

Pneumocephalus can be developed after a dural puncture, which occurs in association with epidural procedures. A 37-year-old, gestational age 40 weeks, pregnant woman was admitted for vaginal delivery. She asked for epidural analgesia when she suffers with labor pain. Epidural anesthesia was done at the L3-L4 interspace with the loss of resistance technique, using air. During the identification of the epidural space, an accidental dural puncture was diagnosed by observing a free flow of CSF, through the needle. The patient developed headache 2 hours later. She was treated with hydration, oxygen, analgesics and the autologus blood patch procedure was done, at the L4-L5 interspace. Despite these measures, the patient's symptoms worsened with nausea and vomiting. A brain CT scan showed the presence of pneumocephalus. After 100% oxygen therapy and metoclopramide injection, she was discharged on postpartum 2 days, without any complications.

Avaliação funcional do transplante autólogo heterotópico de ovários: estudo experimental em ratas / Functional assessment of autologous heterotopic transplant of ovaries: An experimental study on female mice

Introduction: Two facts have been constantly reported in the literature over the lastdecades, namely: the increased number of reproductive-age women with cancer and theincreased age of primiparas. Both facts have encouraged studies on strategies to preserve women?s fertility. Objectives: To perform vaginal swab and morphological study to assess the functional viability of transplanted ovarian tissue. Methods: 30 female Wistar ablbinus mice with preserved hormonal function were randomly distributed in six groups: G1. Control ? laparotomy; G2. Bilateral oophorectomy. G3. Bilateral oophorectomy with intact ovarian implant in the femoral region; G4. Bilateral oophorectomy, with sliced ovarian implant in the femoral region; G5. Bilateral oophorectomy with intact ovarian implant in the great epiploon; G6. Bilateral oophorectomy with sliced ovarian implantat in the great epiploon. Vaginal swab and removal for morphological study of the transplanted ovaries were carried out on the 35th and 120th days after surgery. Groups G3 and G6 were submitted to new vaginal swab on the 150th day. Results: All G1 mice had hormonal function. All G2mice remained in diestrus. The patterns of four G3 mice were consistent with estrus on the 35th day, and one mouse ovulated on the 120th day. Only one G4 mouse remained in diestrus after transplantation. All G5 had functioning ovary. Four G6 mice manifested hormonal function on the 35th day and only three on the 120th day. All the 150th-day swabs were classified as diestrus.Conclusions: Autologous ovarian transplant is technically feasible in female mice as much as vaginal swab for hormonal function assessment.

Splenic autotransplantation plus lower esophagus transaction for the treatment of portal hypertension / 中华普通外科杂志

Objective To evaluate the efficacy of splenic autotransplantation plus lower esophagus transaction for the treatment of portal hypertension(PTH).Methods Thirty patients were divided into study group(15 cases)and control group(15 cases).Patients in study group Underwent splenic autotransplantation after splenectomy and cardia-esophageal devascularization plus lower esophagus transaction,and those in control group had all except splenic autotransplantation.The cross section area,blood velocity,blood flow of MPV(main portal vein)and changes of cardia-esophageal varices were evaluated by 3D DCE MRA at 1 week before operation and 6 months after,and blood flow and collateral circulation of transplanted spleen in the retroperitoneal space were assessed.Results In both groups,the cross section areas(cm2),mean blood velocity(cm/s)and mean blood flow(ml/s)of MPV decreased postoperatively(P＜0.05).The postoperative cross section areas(cm2)and mean blood velocity(cm/s) of MPV in study group were smaller than that in control group(P＜0.05).Esophageal and fundal variceal veins disappeared or improved equally in both groups.There was no difference in the postoperative and preoperative liver function between the two groups(P＞0.05).In study group,the planted spleen grew well in the retroperitoneal space,and with a formation of extensive collateral circulation.The postoperative serum hyaluronic acid decreased in this group(t=2.929,P＜0.05).Conclusion Splenic autotransplantation after splenectomy plus lower esophagus transection was effective for the treatment of PHT without adverse impact on liver function.

The Effect of Autologous Dermis-fixation to Orbital Periosteum in Superior Sulcus Deformity

PURPOSE: To evaluate the efficacy of autologus dermis-fixation on the orbital periosteum in patients with superior sulcus deformity. METHODS: From September 2005 to February 2007, an appropriate amount of a rolled autologus dermis was added to the site of superior sulcus deformity by means of fixation to the orbital periosteum via lid crease incision. Four patients had superior sulcus deformity after undergoing evisceration or other ocular surgeries. RESULTS: Superior sulcus deformities in all patients could be corrected satisfactorily with bilateral symmetry. During the follow-up period, no complications such as mechanical ptosis and recurrence of superior sulcus deformity were observed. CONCLUSIONS: The authors believe that autologus dermis-fixation to the orbital periosteum might be a useful method to correct superior sulcus deformity without disturbing movement of the upper eyelid. A study with a larger series of patients and longer follow-up period might be necessary in the future to obtain more information about autologous dermis-fixation to the periosteum in patients with superior sulcus deformity.

Reconstrução do seio maxilar atrófico com enxerto autólogo de crista ilíaca: avaliação por tomografia computadorizada e radiografia panorâmica / Autologus crest iliac graft in the reconstruction of resorbed maxillary sinus: evaluation through computed tomography and panoramic radiography

OBJETIVOS: As dificuldades para a utilização de implantes dentários osteointegrados em pacientes portadores de atrofia do seio maxilar justificaram o emprego de enxerto autólogo não vascularizado de crista ilíaca isolado ou associado à hidroxiapatita (HA) em 14 pacientes submetidos a 25 procedimentos no Hospital das Nações, Curitiba, Paraná, portadores de atrofia do sinus maxilar. O objetivo foi avaliar comparativamente a precisão da tomografia computadorizada e da radiografia panorâmica, através da quantificação da neoformação óssea nesta estrutura. MÉTODOS: Foram selecionadas pacientes edentados, com altura óssea residual do rebordo gengival ao soalho do seio maxilar menor que 5mm. O enxerto medular de crista ilíaca fragmentada isolado ou misturado com HA foi colocado através da parede lateral no soalho atrófico da cuba maxilar por via submucosa. A avaliação quantitativa e qualitativa foi feita através da radiografia panorâmica e tomografia computadorizada, sendo utilizado na análise estatística a distribuição t de Student (prevalência de 0,05) para análise das variâncias, considerado que a leitura dos laudos radiológicos foi feita por dois especialistas, medindo a distância entre os pontos inferiores e superiores do enxerto no soalho do seio maxilar. RESULTADOS: Tivemos um ganho médio de 14,8mm em todos os procedimentos, com um erro maior que 3mm em 16 procedimentos (64 por cento) e incorporação satisfatória do enxerto ósseo suficiente para futuro implante dentário. CONCLUSÕES: A tomografia computadorizada foi o método de escolha na avaliação qualitativa e quantitativa da incorporação de enxerto autólogo não vascularizado em seio maxilar atrófico.

BACKGROUND:There are different methods to evaluate bone grafts in the maxillary sinus. Panoramic radiography is the most common one, even though assessment could be difficult. Occasionaly computerized tomography (CT)is another option but cost and radiation in excess should be considered. Our objective is to compare these two imaging methods. METHODS: Both panoramic radiogrphy and CT scan methods were used on 25 procedures in 14 patients on post-operative sinus lift with autogenous bone graft from the iliac crest. Two radiologists evaluated the quantity of the newly formed bone and the quality of the exam for each patient, through different imaging groups. RESULTS: The quantitative bone evaluation between the two types of exam showed a statistically significant difference (Student t-test=0,05) In some cases the difference was up to 14,8 mm between exams on the same patient, having an error of more than 3mm in 16 procedures (64 percent). CONCLUSIONS: It can be concluded that the quality of the image on the computerized tomography is superior and it is the most reliable method to determine the area of bone augmentation of the maxillary sinus after an antroplasty.

Relative factors and treatment of the ununited fractures of the diaphysis of radius and ulna / 中华创伤骨科杂志

Objective To explore the possible causes and treatment of nonunion of fractures of diaphysis of radius and ulna. Methods According to different personal conditions and results of X gram, 73 cases of the nonunion fractures of diaphysis of radius and ulna were treated with different internal fixations, autologus spongy bone transplantation, release of scar and interosseous membrane, or local skin flap transposition. All had early functional mobilization of the forearm after operation. Results The patients were followed up for 12 to 29 months. All the cases had bony union, and 64 cases(87.7% ) obtained satisfactory functional rehabilitation. Conclusion The major causes that may lead to the nonunion of the diaphysis of radius and ulna are conditions of local soft tissue, site and severity of the fracture, security of internal fixation, and improper early movement, rather than infection. Proper internal fixation, autologus spongy bone transplantation, and release of scar and interosseous membrane are effective in treatment of the nonunion of the fracture and in the functional rehabilitation of the forearms.

Application of rhG-CSF in patients with plasma cell disease treated with autologus peripheral blood stem cell transplantation / 中国癌症杂志

20?10 6/L were observed in the blood. No patients presented bone pain, fever, abnormal function of liver and kidney, and so on. Conclusions:Our results indicated that rhG-CSF is efficacious and safe in auto-PBSCT for patients with plasma cell diseases. Therefore, the expense of hospitalization would be reduced significantly.